Ur­ticaria has many causes, so see­ing a spe­cial­ist is a good idea

I have re­cently been di­ag­nosed with ur­ticaria af­ter I first de­vel­oped hives in May this year. The con­di­tion is very itchy and can ap­pear on any part of my body. It drives me to dis­trac­tion at times. I take two an­ti­his­tamine tablets when it is se­vere and it nor­mally set­tles down. Any ad­vice? UN­FOR­TU­NATELY this un­com­fort­able con­di­tion is very com­mon, af­fect­ing 15-25 per cent of the pop­u­la­tion at some time in their lives. Hav­ing had it for more than six weeks, you are now said to have chronic ur­ticaria. What to do about it (aside from tak­ing an­ti­his­tamines) largely de­pends on the cause. Ur­ticaria is the re­sult of his­tamine and other sim­i­lar va­soac­tive chem­i­cals be­ing re­leased into the skin, and this can hap­pen for many rea­sons. Some of th­ese rea­sons in­clude al­ler­gic re­ac­tions to sub­stances, but you could also be hav­ing a non-al­ler­gic re­ac­tion to cer­tain medicines, a vi­ral in­fec­tion or cer­tain foods. Some­times chronic ur­ticaria is a sign of an auto-im­mune dis­ease (the body mount­ing an im­mune re­ac­tion against it­self) and can be as­so­ci­ated with sim­i­lar dis­eases such as thy­roid dis­ease. There are also forms of ur­ticaria that are trig­gered by sweat­ing or when the skin heats up af­ter be­ing cold. Oc­ca­sion­ally the con­di­tion is caused by con­tact with a sub­stance. There is quite a range of pos­si­bil­i­ties which would make con­sul­ta­tion with a spe­cial­ist worth­while. I ama healthy 63-year-old wo­man, in fairly good shape. As a 50-some­thing I did the usual menopause thing, in that I went on HRT for five years or so. My prob­lem was present even on HRT, and un­for­tu­nately is still with me— vagi­nal dry­ness. This is as­so­ci­ated with itch­i­ness and ir­ri­ta­tion. Even top­i­cal oe­stro­gen doesn’t help much, nor do per­sonal lu­bri­cants. My hus­band is very un­der­stand­ing, and while we still have a sex life it could be a lot bet­ter. AL­THOUGH vagi­nal dry­ness does af­fect many women af­ter menopause, es­pe­cially if they are not tak­ing hor­mone re­place­ment ther­apy, it is usu­ally helped by top­i­cal oe­stro­gen in the form of creams or pes­saries, and/or lu­bri­cants. For per­sis­tent dry­ness, as in your case, it is very im­por­tant that you get med­i­cally checked to en­sure there is noth­ing else go­ing on. In par­tic­u­lar, you want to check for a skin con­di­tion known as lichen scle­ro­sus, which can cause sim­i­lar symp­toms— in par­tic­u­lar vagi­nal itch­ing — and, while rare, is more com­mon in women who have been through menopause. It clas­si­cally ap­pears as thin white ar­eas of skin of the vulva that can lead to tears and bruis­ing. It’s im­por­tant to di­ag­nose this con­di­tion, firstly be­cause the treat­ment is quite dif­fer­ent to nor­mal oe­stro­gen-de­fi­cient dry­ness. Lichen scle­ro­sus is treated with quite po­tent steroid creams or oint­ments. Sec­ond, if the con­di­tion re­mains un­treated it can lead to scar­ring and pos­si­bly can­cer. My 10-year-old son was re­cently di­ag­nosed as hav­ing Henoch-Schon­lein pur­pura af­ter a red rash de­vel­oped on his legs. Are there any risks as­so­ci­ated with this con­di­tion? HENOCH-Schon­lein pur­pura is a con­di­tion in which the blood ves­sels be­come ir­ri­tated and swollen, caus­ing a rash that looks like lots of tiny bruises. It com­monly af­fects lower limbs, but can ex­tend to the but­tocks and oc­ca­sion­ally the up­per limbs. Some­times the blood ves­sels in the bowel and kid­neys can be af­fected, caus­ing blood to ap­pear in the bowel mo­tions or urine, though this is less com­mon. Rarely, Henoch-Schon­lein pur­pura can be as­so­ci­ated with joint pains or col­icky ab­dom­i­nal pain. As for long-term con­se­quences, most peo­ple with HenochS­chon­lein Pur­pura will get bet­ter with­out any treat­ment be­ing nec­es­sary, es­pe­cially in the group it most com­monly af­fects — the 2-10-year-olds. How­ever, it is still worth­while get­ting your son checked reg­u­larly be­cause rarely the con­di­tion may cause kid­ney prob­lems. It is also pos­si­ble to have a re­cur­rence of Henoch-Schon­lein pur­pura, but this does not mean there is any sin­is­ter longterm prob­lem. Linda Cal­abresi is ed­i­tor of Path­way , the mag­a­zine of the Royal Col­lege of Pathol­o­gists of Aus­trala­sia, and a Syd­ney GP. Send your queries to lin­da­cal­abresi@gmail.com